FKP Fort Walton Beach Senior Living Tenant LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FKP FORT WALTON BEACH SENIOR LIVING TENANT LLC

Doing business as

Belvedere Commons of Fort Walton Beach

Practice address

2000 Principal LN
Fort Walton Beach, FL 32547-6636

Phone

(850) 243-7735

NPI assigned

Aug 18, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ayla Harwood

Title

Coo

Phone

(239) 292-1513

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Belvedere Commons of Fort Walton Beach Doing business as

Electronic endpoints 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1184342867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PRINCIPAL LN",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476636",
            "telephone_number": "850-243-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PRINCIPAL LN",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476636",
            "telephone_number": "850-243-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FKP FORT WALTON BEACH SENIOR LIVING TENANT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-18",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "HARWOOD",
        "authorized_official_first_name": "AYLA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "239-292-1513"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Local",
            "affiliation": "N",
            "endpointDescription": "Local endpoints",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2000 Principal Ln",
            "city": "Fort Walton Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325476636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Belvedere Commons of Fort Walton Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sheraefien Finch
• Melissa Josephine Fischer, M.D.
• Howard Fisher, DDS
• Danielle Fitzgerald, BCBA
• Rylee Fiveash, MA CCC SLP
• FL-I Medical Services LLC
• Laura M. Flaherty, PT
• Leslie R Fleischer, M.D.
• Jamie Marie Flink, CRNA
• Jessica Flores

• Assisted Living Facility in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.